{"ref":"GA-HC-ETH-03","title":"Compliance Program and Exclusion Screening","category":"Ethics","summary":"Sets up the Agency's compliance program: a person responsible for compliance, written standards, training, a way to raise concerns without retaliation, auditing, and a prompt response to problems. It requires screening of every staff member and contractor against federal and Georgia exclusion lists before hire and monthly, and explains the false claims and anti-kickback rules that apply when the Agency bills Medicaid.","inShort":["Bill and record only what really happened. A false visit record can be fraud under Georgia and federal law.","Everyone is checked against exclusion lists before hire and every month. Tell the Administrator if you are excluded.","Never give or accept money or gifts for client referrals.","Report any concern about billing, records or fraud to your supervisor or the Administrator. You can do it anonymously.","You are protected by law from retaliation for reporting in good faith."],"primaryCitation":"O.C.G.A. §49-4-168 et seq.","citations":["O.C.G.A. §49-4-168","O.C.G.A. §49-4-168.1","O.C.G.A. §49-4-168.4","O.C.G.A. §31-7-351(14)","O.C.G.A. §31-7-352"],"federalCitations":["42 U.S.C. §1320a-7","42 U.S.C. §1320a-7a(a)(6)","42 U.S.C. §1320a-7b(b)","42 U.S.C. §1320a-7k(d)","31 U.S.C. §3729","31 U.S.C. §3730(h)","42 U.S.C. §1396a(a)(68)","42 CFR §1001.1901"],"surveyorAsks":["Who is responsible for compliance at your agency, and how do staff report a concern?","Show me your exclusion screening for this employee at hire and for the last three months."],"forms":[{"ref":"GA-HC-ETH-03-A","title":"Monthly Exclusion Screening Log"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (O.C.G.A. §49-4-168 et seq.)","5. Elements of the Compliance Program","6. Exclusion Screening","7. False Claims and Kickbacks","8. Responding to a Problem","9. Responsibilities","10. Records and Compliance Monitoring","11. Staff Training","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"ga-phc","state":"Georgia","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}